Abstract
Aim: To assess whether an airway assessment score based on the LEMON method is able to predict difficulty at intubation in the emergency department.
Methods: Patients requiring endotracheal intubation in the resuscitation room of a UK teaching hospital between June 2002 and September 2003 were assessed on criteria based on the LEMON method. At laryngoscopy, the Cormack and Lehane grade was recorded. An airway assessment score was devised and assessed.
Results: 156 patients were intubated during the study period. There were 114 Cormack and Lehane grade 1 intubations, 29 grade 2 intubations, 11 grade 3 intubations, and 2 grade 4 intubations. Patients with large incisors (p<0.001), a reduced inter-incisor distance (p<0.05), or a reduced thyroid to floor of mouth distance (p<0.05) were all more likely to have a poor laryngoscopic view (grade 2, 3, or 4). Patients with a high airway assessment score were more likely to have a poor laryngoscopic view compared with those patients with a low airway assessment score (p<0.05).
Conclusions: An airway assessment score based on criteria of the LEMON method is able to successfully stratify the risk of intubation difficulty in the emergency department. Patients with a poor laryngoscopic view (grades 2, 3, or 4) were more likely to have large incisors, a reduced inter-incisor distance, and a reduced thyroid to floor of mouth distance. They were also more likely to have a higher airway assessment score than those patients with a good laryngoscopic view.
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Selected References
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- Arné J., Descoins P., Fusciardi J., Ingrand P., Ferrier B., Boudigues D., Ariès J. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth. 1998 Feb;80(2):140–146. doi: 10.1093/bja/80.2.140. [DOI] [PubMed] [Google Scholar]
- Cormack R. S., Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984 Nov;39(11):1105–1111. [PubMed] [Google Scholar]
- Frerk C. M. Predicting difficult intubation. Anaesthesia. 1991 Dec;46(12):1005–1008. doi: 10.1111/j.1365-2044.1991.tb09909.x. [DOI] [PubMed] [Google Scholar]
- Graham C. A., Beard D., Oglesby A. J., Thakore S. B., Beale J. P., Brittliff J., Johnston M. A., McKeown D. W., Parke T. R. J. Rapid sequence intubation in Scottish urban emergency departments. Emerg Med J. 2003 Jan;20(1):3–5. doi: 10.1136/emj.20.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harrison G. R. The effect of posture on cerebral oxygenation during abdominal surgery. Anaesthesia. 2001 Dec;56(12):1181–1184. doi: 10.1046/j.1365-2044.2001.02084.x. [DOI] [PubMed] [Google Scholar]
- Mackay C. A., Terris J., Coats T. J. Prehospital rapid sequence induction by emergency physicians: is it safe? Emerg Med J. 2001 Jan;18(1):20–24. doi: 10.1136/emj.18.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mallampati S. R., Gatt S. P., Gugino L. D., Desai S. P., Waraksa B., Freiberger D., Liu P. L. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985 Jul;32(4):429–434. doi: 10.1007/BF03011357. [DOI] [PubMed] [Google Scholar]
- Oates J. D., Macleod A. D., Oates P. D., Pearsall F. J., Howie J. C., Murray G. D. Comparison of two methods for predicting difficult intubation. Br J Anaesth. 1991 Mar;66(3):305–309. doi: 10.1093/bja/66.3.305. [DOI] [PubMed] [Google Scholar]
- Reed Matthew J., Rennie Louise M., Dunn Mark J. G., Gray Alasdair J., Robertson Colin E., McKeown Dermot W. Is the 'LEMON' method an easily applied emergency airway assessment tool? Eur J Emerg Med. 2004 Jun;11(3):154–157. doi: 10.1097/01.mej.0000127645.46457.b9. [DOI] [PubMed] [Google Scholar]
- Rocke D. A., Murray W. B., Rout C. C., Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology. 1992 Jul;77(1):67–73. doi: 10.1097/00000542-199207000-00010. [DOI] [PubMed] [Google Scholar]
- Rose D. K., Cohen M. M. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994 May;41(5 Pt 1):372–383. doi: 10.1007/BF03009858. [DOI] [PubMed] [Google Scholar]
- Tse J. C., Rimm E. B., Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesth Analg. 1995 Aug;81(2):254–258. doi: 10.1097/00000539-199508000-00008. [DOI] [PubMed] [Google Scholar]
- Wilson M. E., Spiegelhalter D., Robertson J. A., Lesser P. Predicting difficult intubation. Br J Anaesth. 1988 Aug;61(2):211–216. doi: 10.1093/bja/61.2.211. [DOI] [PubMed] [Google Scholar]
- el-Ganzouri A. R., McCarthy R. J., Tuman K. J., Tanck E. N., Ivankovich A. D. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg. 1996 Jun;82(6):1197–1204. doi: 10.1097/00000539-199606000-00017. [DOI] [PubMed] [Google Scholar]